Abstract

Introduction. Surgery-induced oxidative stress increases the risk of perioperative complications and delay in postoperative recovery. In mice, short-term preoperative dietary and protein restriction protect against oxidative stress. We investigated the feasibility of a calorie- and protein-restricted diet in two patient populations. Methods. In this pilot study, 30 live kidney donors and 38 morbidly obese patients awaiting surgery were randomized into three groups: a restricted diet group, who received a synthetic liquid diet with 30% fewer calories and 80% less protein for five consecutive days; a group who received a synthetic diet containing the daily energy requirements (DER); and a control group. Feasibility was assessed using self-reported discomfort, body weight changes, and metabolic parameters in blood samples. Results. Twenty patients (71%) complied with the restricted and 13 (65%) with the DER-diet. In total, 68% of the patients reported minor discomfort that resolved after normal eating resumed. The mean weight loss on the restricted diet was significantly greater (2.4 kg) than in the control group (0 kg, p = 0.002), but not in the DER-diet (1.5 kg). The restricted diet significantly reduced levels of serum urea and plasma prealbumin (PAB) and retinol binding protein (RBP). Conclusions. A short-term preoperative calorie- and protein-restricted diet is feasible in kidney donors and morbidly obese patients. Compliance is high and can be objectively measured via changes in urea, PAB, and RBP levels. These results demonstrate that this diet can be used to study the effects of dietary restriction on surgery-induced oxidative stress in a clinical setting.

Highlights

  • Surgery-induced oxidative stress increases the risk of perioperative complications and delay in postoperative recovery

  • In our previous pilot study in live kidney donors, we showed that three days of 30% dietary restriction (DR) followed by 24 h of fasting prior to kidney donation was feasible and safe, but had limited effects on outcome [15,16]

  • Our results showed that short-term DR is feasible and represents a promising step in investigating the effects of preoperative DR on surgery-related outcome in a clinical setting

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Summary

Introduction

Surgery-induced oxidative stress increases the risk of perioperative complications and delay in postoperative recovery. Short-term preoperative dietary and protein restriction protect against oxidative stress. In this pilot study, 30 live kidney donors and 38 morbidly obese patients awaiting surgery were randomized into three groups: a restricted diet group, who received a synthetic liquid diet with 30% fewer calories and 80% less protein for five consecutive days; a group who received a synthetic diet containing the daily energy requirements (DER); and a control group. Nutrients 2016, 8, 306 and may hamper postoperative recovery [1,3] This risk is increased by preexisting factors such as obesity [4], and by perioperative factors such as ischemia-reperfusion injury (IRI) during organ transplantation [5,6]. The beneficial effects of fasting on renal IRI are observed in aged obese mice of both sexes, suggesting that DR induces protection against ROS independent of age and sex [11]

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